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INTERESTING CARDIOTHORACIC IMAGE Table of Contents   
Year : 2007  |  Volume : 10  |  Issue : 1  |  Page : 61-62
Absent left main coronary artery


Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University Hospital, London, Ontario., Canada

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How to cite this article:
Goel S, Dhir A. Absent left main coronary artery. Ann Card Anaesth 2007;10:61-2

How to cite this URL:
Goel S, Dhir A. Absent left main coronary artery. Ann Card Anaesth [serial online] 2007 [cited 2019 Aug 18];10:61-2. Available from: http://www.annals.in/text.asp?2007/10/1/61/37928


A 55-year-old male was admitted with the diagnosis of bicuspid aortic valve, severe aortic regurgitation, moderate aortic stenosis, and ascending aortic aneurysm. His preoperative Computed tomographic - angiogram of the heart revealed separate origin of left anterior descending artery (LAD) and left circumflex artery (LCX) i.e. absent left main coronary artery [Figure 1]. Intraoperative transoesophageal echocardiography also showed two separate origins of LAD and LCX, respectively. [Figure 2] He underwent modified Bentall's procedure. During reimplantation of both LAD and LCX, it was found that the pericardial cuff around the opening of these arteries was too thin to support the anastomosis with the Dacron graft [Figure 3]. Therefore, surgeons decided to use extra pericardial tissue to support the anastomosis.

Adult congenital anomalies of the coronary arteries are not common and are usually casual findings of diagnostic angiographic studies. The incidence in literature varies from less than 1% to as high as 5.6%. [1] Amongst these, the incidence of absent left main coronary artery has been reported to be 0.67%. [2] Anomalous coronary arteries may sometime be associated with some congenital heart disease like bicuspid aortic valve. Therefore, the angiographic recognition of these vessels is important during coronary angioplasty or cardiac surgery.

 
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1.Budoff MJ, Ahmed V, Gul KM, Mao SS, Gopal A. Coronary anomalies by cardiac computed tomographic angiography. Chin Cardiol 2006; 29: 489-493.  Back to cited text no. 1    
2.Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology and clinical relevance. Circulation 2002; 105: 2449-2454.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Sanjay Goel
Department of Anaesthesia and Perioperative Medicine, University Hospital, London Health Sciences, Centre, 339, Windermere Road, London, Ontario, N6A 5A5
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.37928

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